Papillary thyroid carcinoma: the impact of histologic vascular invasion.

OBJECTIVE: The American Thyroid Association (ATA) recurrence risk prediction system considers vascular invasion (VI) as a relative indicator for adjuvant radioactive iodine (RAI) treatment, nevertheless VI final role in PTC management is yet to be defined. This study aims to assess the impact of histologic VI in PTC. METHODS: A retrospective study with PTC patients admitted in our Thyroid Cancer Unit, between January 1960 and December 2016 was performed. We reviewed 905 patient records with 275 having full information about VI on their pathological reports. Demographic and clinical variables were obtained, and univariate/multivariate analysis was performed in order to obtain potential predictive prognostic factors. RESULTS: Fifty-one out 275 patients presented VI (18.5%; 95% CI 14.4 - 23.6%), these individuals had larger tumors (median 19mm vs 12 mm, p < 0.001) with more frequent extraglandular invasion (54.0% vs 17.1%, p<0.001), regional lymph nodes involvement (29.8% vs 12.6%, p = 0.003)and distant metastasis (10.9% vs 1.9%, p = 0.003) at diagnosis. Vascular invasion was an independent predictor for regional lymph node and/or distant metastasis at diagnosis [OR 2.93 (IC95% 1.16 - 7.41, p = 0.008)]. After a median follow-up time was 68.5 months patients with VI presented higher rates of local recurrence and lymph node metastasis recurrence. CONCLUSIONS: In this study, the presence of VI in PTC is associated to higher rate of lymph node and distant metastasis at diagnosis. Its presence should be probably considered an adverse prognostic factor in PTC, perhaps justifying more aggressive therapeutic and follow-up approaches in such cases.

Differentiated thyroid cancer in patients with resistance to thyroid hormone syndrome. A novel case and a review of the literature.

Resistance to thyroid hormone (RTH) represents a syndrome in which patients present elevated circulating thyroid hormones in the presence of non-suppressed TSH. We report a novel case where a patient with RTH presented a differentiated thyroid cancer. A19 year-old female had been referred due to thyroid disease that disclosed features characteristic of a RTH. During the follow up it was detected a follicular tumor that led to the recommendation for thyroid surgical ablation, where an incidental papillary thyroid microcarcinoma (mPTC) was found. The increase of thyroglobulin (TG) levels following thyroid removal referred the patient for radioiodine treatment. Post-treatment, it was detected jugular adenopathies and the patient was subjected to cervical lymph node drainage where metastases of the mPTC were found. RTH syndrome was confirmed by the detection of a THRB germline mutation. A BRAF mutation was also found in the mPTC but not detected in the follicular adenoma or normal adjacent tissue. The young age of the patient, the rarity of BRAF mutations in childhood and the high dissemination of the malignancy, lead us to the speculation that increased TSH stimulation in a RTH background and oncogenic activation of BRAF could have served as (co) drivers and might have triggered an advanced stage of the neoplastic disease. These findings together with a review of published cases add novel information to the management of RTH patients with differentiated thyroid cancer.

Thyroid storm and arrhythmic storm: a potentially fatal combination.

Thyroid storm is a rare clinical emergency with a mortality rate between 20% and 30%. Cardiac arrhythmias associated with thyrotoxicosis are usually supraventricular. Ventricular arrhythmias are rarely associated with this entity and tend to occur in patients with intrinsic cardiac disease. We present a 35-year-old woman with Graves disease and a thyroid storm manifested with multiple malignant dysrhythmic episodes, without underlying cardiac disease. The mechanism for ventricular arrhythmia is not clear but seems to be due to the increased myocardial excitability directly caused by the thyroid hormones. The presence of myocarditis lesions may constitute an arrhythmogenic substratum and contribute further to this manifestation. This case emphasizes the importance of cardiac monitoring in patients with thyroid storm.

[Iodine intake in Portuguese school children]. / Aporte do Iodo nas Crianças das Escolas em Portugal.

OBJECTIVE: The aim of the present study was to evaluate iodine intake in portuguese school children in order to inform health authorities of eventual measures to be implemented. INTRODUCTION: Iodine is the key element for thyroid hormone synthesis and its deficiency even mild, as found in other European countries, may have deleterious effects in pregnancy resulting in cognitive problems of offsprings. In Portugal there are no recent data on iodine intake in schoolchildren. POPULATION AND METHODS: 3680 children aged 6-12 years of both sexes, from 78 different schools were studied. Iodine intake was evaluated trough urine iodine (UI) determinations using a colorimetic method. RESULTS: The global median UI value was 105.5 µg/L; the percentage of children with UI <100 µg/L was 47.1%, corresponding to 41% of the studied schools. The percentage of values <50 µg/L was 11.8%. The male gender, the south region of the country and the distribution of milk in school were significantly linked with a higher iodine elimination. DISCUSSION: Our global results point to a borderline/ mildly insufficient iodine intake in the portuguese school population. However 47% of the children had UI under 100 µg /L. The comparison of our results with the available data from 30 years ago, point to a considerable improvement, due to silent prophylaxis. Male gender, geographical area and milk distribution influenced positively iodine intake.The importance of milk has been referred in numerous papers. CONCLUSIONS: The study of UI in the Portuguese school population points to a borderline iodine intake. However, in 47% of children iodine intake was inadequate. Compared with data from the eighties, a considerable increase in iodine elimination was found. Taking into account the potencial deleterious effects of inadequate iodine intake, a global prophylaxis with salt iodization has to be considered.

Antimicrobial effect of chlorhexidine digluconate in dentin: In vitro and in situ study.

AIM: The aim of this study was to evaluate a very short-term in vitro and in situ effect of 2% chlorhexidine-digluconate-based (CHX) cavity cleanser on the disinfection of dentin demineralized by cariogenic bacteria. MATERIALS AND METHODS: Human dentin slabs were randomly allocated and used in 2 distinct phases, in vitro and in situ, for obtaining demineralized dentin. In vitro, the slabs (n=15) were immersed for 5 days in BHI broth inoculated with Streptococcus mutans CTT 3440. In situ, a double-blind design was conducted in one phase of 14 days, during which 20 volunteers wore palatal devices containing two human dental dentin slabs. On 5(th) day in vitro and 14(th) day in situ, the slabs were allocated to the two groups: Control group (5 µl of 0.9% NaCl solution) and CHX group (5 µl of 2% chlorhexidine digluconate solution, Cavity Cleanser™ BISCO, Schaumburg, IL, EUA), for 5 minutes. The microbiological analyses were performed immediately before and after the treatments. RESULTS: The log reductions means found for CHX treatment on tested micro organisms were higher when compared to Control group either in vitro or in situ conditions. CONCLUSIONS: Our results showed that CHX was effective in reducing the cultivable microbiota in contaminated dentin. Furthermore, although the use of chlorhexidine-digluconate-based cavity disinfectant did not completely eliminate the viable microorganisms, it served as a suitable agent to disinfect tooth preparations.

Esthetic considerations for reshaping of autotransplanted premolars replacing maxillary central incisors: a case report.

Autotransplantation is a safe and currently common procedure in cases of agenesis and tooth loss. Autotransplantation of premolars to replace missing maxillary central incisors has been shown to be an excellent treatment choice, especially in young patients in the 9-12-year-old age range. The choice for adequate restorative materials and techniques is also essential, direct composite resin being indicated in most cases. This paper reports the case of two premolars autotransplanted to replace both maxillary central incisors and addresses the esthetic issues involved in the reshaping of these teeth to incisor morphology.

Evaluation of the antimicrobial effect of photodynamic antimicrobial therapy in an in situ model of dentine caries.

Photodynamic antimicrobial therapy (PACT) promotes bacterial death as a result of the photosensitization of microbial components. This study evaluated the effect of PACT on dentine caries produced in situ. Over the course of 14 d, 20 volunteers wore intra-oral devices containing human dentine slabs that were treated 10 times daily with a 40% sucrose solution. Afterwards, the antimicrobial effect of toluidine blue O, associated with 47 or 94 J cm(-2) of a light-emitting diode, was evaluated. Before and after the treatments, dentine samples were analysed with regard to the total number of microorganisms, total streptococci, mutans streptococci, and lactobacilli. Significant reductions in the bacterial count were observed for PACT with both energy densities tested, with the following values observed for 47 and 94 J cm(-2) of irradiation: for total streptococci, 3.45 and 5.18; for mutans streptococci, 3.08 and 4.16; for lactobacilli, 3.24 and 4.66; and for total microorganisms, 4.29 and 5.43, respectively. The control, treated with 94 J cm(-2) of irradiation alone, was also effective against all bacteria. To conclude, PACT was effective in killing oral microorganisms present in dentine caries produced in situ and may be a useful technique for eliminating bacteria from dentine carious lesions before restoration.

[The Neuropad test in the screening of peripheral neuropathy in diabetic patients]. / O teste com Neuropad na detecção precoce da neuropatia periférica do doente diabético.

One of the first signs of peripheral neuropathy is the loss of perspiration of the feet. Untill now, the Semmes-Weinstein monofilament test has been considered the gold test to detect early peripheral neuropathy. Recently, the Neuropad test has become available: it is a cobalt salt plaster designed to change colour from blue to pink in contact with liquids, namely sweating. The objective of this study was to find if the Neuropad test could be considered as a test for detecting peripheral autonomic neuropathy and to compare its sensitivity and specificity to the Semmes-Weinstein monofilament test. Forty diabetic patients were studied, 22 of them presented with peripheral neuropathy. The criteria used for the definition of neuropathy was based on the Neuropathy Disability Score (NDS). Under Semmes-Weinstein monofilament test, we found a sensitivity and specificity of 82% and 94%, respectively, and with the Neuropad test, a specificity of 44%, but a sensitivity of 100%. Ten patients presented a sudomotor dysfunction of the feet in the absence of peripheral neuropathy (based on the NDS criteria), and were considered as false positives. We concluded that the Neuropad test is a simple, sensitive test to screen for diabetic neuropathy. Based on the false positive results, we may consider it as a reliable test detecting neuropathy in a earlier phase.

Encuesta sobre el tratamiento del carcinoma diferenciado de tiroides / Treatment of difeerentiated thyroid carcinoma: a survey

Introducción: En enero de 2005, durante la reunión anual de la Sociedad Portuguesa de Endocrinología, Diabetes y Metabolismo, se entregó a los médicos presentes una encuesta sobre el modo de actuación en el tratamiento y el seguimiento del carcinoma diferenciado de tiroides. Es objetivo de este trabajo dar a conocer los resultados de esa encuesta. Métodos: El cuestionario versaba esencialmente sobre los siguientes puntos: tratamiento quirúrgico de la glándula y cadenas ganglionares, gammagrafía y ablación con 131I, supresión con levotiroxina, tratamiento de las recidivas y metástasis. Se obtuvieron 54 respuestas (el 79% de los endocrinólogos).Resultados: Ante el diagnóstico de carcinoma diferenciado de tiroides latiroidectomía total es siempre preferida por el 67% de los encuestados. La totalización, en caso de diagnóstico posquirúrgico, es recomendada por el70% en el carcinoma papilar, por el 67% en el microcarcinoma papilar y por el 44% en el folicular con invasión mínima. La gran mayoría recomienda vaciamiento ganglionar si los ganglios están afectados; el61% realiza sistemáticamente gammagrafía con 131I tras la cirugía; el 28%de los interrogados hacen ablación de restos tumorales, además del 59%que la hacen si hay captación de 131I en el lecho tiroideo, si la tiroglobulina está aumentada o si hay factores de riesgo; 100 m Ci es la dosis más usada. No hubo unanimidad en relación con el grado de supresión de tirotropina. En caso de recidiva y metástasis, apenas el 22% de los encuestados refiere la cirugía como primera opción terapéutica y el 57%prefiere el 131I en el tratamiento de la recidiva local. Mas del 50% escogió la tomografía computarizada para el diagnóstico de recidiva de enfermedad en los casos en que la tiroglobulina permanece elevada y la gammagrafía corporal con 131I fuese negativa. Conclusiones: La gran variabilidad de respuestas en este cuestionario y un porcentaje significativo (11-41%) de no respondedores evidencian la falta de uniformidad de los protocolos de tratamiento del carcinoma de tiroides en Portugal. Según las guías publicadas y las respuestas a un cuestionario semejante realizado en España, las grandes diferencias de actuación surgen principalmente en la cuestión del vaciamiento ganglionar y en el tratamiento de la recidiva de la enfermedad (AU)

Introduction: In January 2005, during the annual meeting of the Portuguese Society of Endocrinology, Diabetes and Metabolism, a questionnaire on the treatment and follow-up of differentiated thyroid carcinoma (DTC) was given to attendants. The aim of this study was to present the survey’s results. Methods: The questionnaire addressed the following issues: the surgical treatment of the gland and cervical lymph nodes, whole body scan and ablation with 131I, suppression with levothyroxine, and treatment of recurrence and metastases. Fifty-four completed questionnaires were obtained(79% from clinical endocrinologists).Results: When DTC is diagnosed, 67% of respondents reported that total thyroidectomy is always performed. When the diagnosis is made postsurgically, completion of thyroidectomy is recommended by 70% of respondents for papillary carcinoma, by 67% for papillarymicrocarcinoma and by 44% for minimallyinvasive follicular carcinoma. Most respondents recommend lymph nodedissection if the nodes are involved; 61%systematically perform whole body scan with 131I after surgery. Twenty-eightpercent routinely perform ablation of the thyroid, and 59% request adjuvant radioiodine ablation of the thyroid bed if there is 131I uptake, if thyroglobulin is increased, or if risk factors are present. The most commonly used ablation dose is 100mCi. Consensus on the degree of TSH suppression is lacking. Twenty-two percent of the respondents recommend surgery as the first therapeutic option in recurrence and metastases, while 57% prefer 131I for the treatment of local recurrence. When thyroglobulin levels remain high and the results of 131I scanning are negative, 50%choose computed tomography scan for the diagnosis of disease recurrence. Conclusions: The wide variability of responses in this survey and the significant percentage (11 to 41%) of non-responders demonstrates the lack of uniformity in the treatment protocols for DCT in Portugal. According to the published guidelines and the responses to a similar survey performed in Spain, the widest differences are mainly found in lymph node dissection and the treatment of disease recurrence (AU)

Treatment of differentiated thyroid carcinoma: a survey.

INTRODUCTION: In January 2005, during the annual meeting of the Portuguese Society of Endocrinology, Diabetes and Metabolism, a questionnaire on the treatment and follow-up of differentiated thyroid carcinoma (DTC) was given to attendants. The aim of this study was to present the survey's results. METHODS: The questionnaire addressed the following issues: the surgical treatment of the gland and cervical lymph nodes, whole body scan and ablation with (131)I, suppression with levothyroxine, and treatment of recurrence and metastases. Fifty-four completed questionnaires were obtained (79% from clinical endocrinologists). RESULTS: When DTC is diagnosed, 67% of respondents reported that total thyroidectomy is always performed. When the diagnosis is made postsurgically, completion of thyroidectomy is recommended by 70% of respondents for papillary carcinoma, by 67% for papillary microcarcinoma and by 44% for minimally invasive follicular carcinoma. Most respondents recommend lymph node dissection if the nodes are involved; 61% systematically perform whole body scan with (131)I after surgery. Twenty-eight percent routinely perform ablation of the thyroid, and 59% request adjuvant radioiodine ablation of the thyroid bed if there is (131)I uptake, if thyroglobulin is increased, or if risk factors are present. The most commonly used ablation dose is 100 mCi. Consensus on the degree of TSH suppression is lacking. Twenty-two percent of the respondents recommend surgery as the first therapeutic option in recurrence and metastases, while 57% prefer (131)I for the treatment of local recurrence. When thyroglobulin levels remain high and the results of (131)I scanning are negative, 50% choose computed tomography scan for the diagnosis of disease recurrence. CONCLUSIONS: The wide variability of responses in this survey and the significant percentage (11 to 41%) of non-responders demonstrates the lack of uniformity in the treatment protocols for DCT in Portugal. According to the published guidelines and the responses to a similar survey performed in Spain, the widest differences are mainly found in lymph node dissection and the treatment of disease recurrence.

A prospective, multicentre study to investigate the efficacy, safety and tolerability of octreotide LAR (long-acting repeatable octreotide) in the primary therapy of patients with acromegaly.

OBJECTIVE: To evaluate the efficacy, safety and tolerability of octreotide LAR (long-acting repeatable octreotide) in the primary therapy of acromegaly. DESIGN AND PATIENTS: Ninety-eight previously untreated acromegalics were recruited into this prospective multicentre study. A total of 68 patients successfully completed 48 weeks of the study period, received 12 doses of octreotide LAR 10-30 mg every 4 weeks, and constituted the population used for this analysis. MEASUREMENTS AND RESULTS: A clinically relevant reduction (i.e. to < or = 5 microg/l) in mean GH (mGH) was recorded in 72% of patients after 24 weeks of treatment, and 42% reached a 'safe' GH value (< or = 2.5 microg/l). At week 48, 16 more patients were considered partial GH responders (GH > 2.5 microg/l and < or = 5 microg/l) and 44% had reached a GH level < or = 2.5 microg/l. IGF-1 levels normalized in 38% and 34% of patients after 24 and 48 weeks of treatment, respectively. At study completion, 10 patients (14.7%) who had not normalized their IGF-1 levels had achieved at least a 50% decrement in this marker. In eight microadenoma patients, tumour volume decreased from a mean baseline level of 298 +/- 145 mm3 to 139 +/- 94 mm3 after 24 weeks and to 99 +/- 70 mm3 after 48 weeks of therapy. In 60 patients with macroadenoma, the corresponding values were 3885 +/- 5077 mm3 at baseline and 2723 +/- 3435 and 2406 +/- 3207 mm3 after 24 and 48 weeks, respectively. At weeks 24 and 48, a significant (> 20%) tumour volume reduction was reported in 63% and 75% of patients, respectively. A reduction in the severity of symptoms of acromegaly was observed early in treatment and was maintained throughout the study period. CONCLUSION: Octreotide LAR represents a viable alternative to surgery for primary treatment of acromegaly leading to a progressive regression of tumour volume, a sustained control of biochemical abnormalities and an adequate relief of symptoms of the disease.

[Treatment and follow up protocol in differentiated thyroid carcinomas of follicular origin]. / Protocolo de tratamento e seguimento dos carcinomas diferenciados da tiróide de origem folicular.

Differentiated thyroid carcinoma of follicular origin (DTCFO), although not very frequent, has registered a raising incidence in the last decades. In the majority of the cases, DTCFO is a curable disease when treated and monitored by experienced, multidisciplinary teams. These factors contribute to an increasing number of DTCFO survivors requiring life-long monitoring, due to the possibility of occurrence of recurrences many years after the initial treatment. Several aspects of the treatment and management of these patients are still controversial. The present protocol represents the consensus of the members of the Grupo de Estudo da Tiróide of the Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo. It aims to define guidelines, in agreement with the current state of the art and contemplating the necessary adaptations to local constrains, that ensure decreased mortality and protection of patients' quality of life, avoiding unnecessarily aggressive or ineffective treatments, optimizing the use of the available resources.

[Clinical and demographic characteristics of 99 episodes of rheumatic fever in Acre, the Brazilian Amazon]. / Características clínicas demográficas em 99 episódios de febre reumática no Acre, Amazônia Brasileira.

OBJECTIVE: To report clinical manifestations and demographic characteristics of patients with rheumatic fever treated in a public hospital in the state of Acre. METHODS: A cross-sectional study was conducted of patients consecutively seen in the Cardiology Ward at FUNDHACRE Demographic, clinical and laboratory data were assessed through a questionnaire. The diagnosis of rheumatic fever was made based on Jones' criteria, associated with laboratory data, electrocardiography, chest X-ray, and bi-dimensional echocardiography. Patients with other heart diseases, diabetes, obesity, inflammatory disease, and infections were excluded. Those who smoked, were pregnant, or used anti-inflammatory medication or hormone therapy were also excluded. RESULTS: From July 2003 to February 2004, 99 patients with rheumatic fever were assessed (mean age, 11 years, SD= +/- 10.18) with a predominance of females (59.6%), and a racial phenotype of a mixture of Caucasian and Indian (60.6%). Three individuals were excluded because they did not meet the diagnostic criteria. Mean age was 9.1 years old, and in 30.4% of the patients, the disease was diagnosed at the first episode of rheumatic fever. The most frequent clinical manifestations were carditis (69.7%), arthritis (21.4%), and chorea (6.1%). Mitral regurgitation was the most common lesion (36.4%) followed by the association of mitral regurgitation and aortic regurgitation (9.1%). CONCLUSION: Rheumatic carditis was the most common manifestation of rheumatic fever, predominant in the group with a racial mixture of Caucasian and Indian (60.6%). Low compliance with antibiotic therapy contributed to the recurrence of the disease and to cardiac sequelae.

Características clínicas demográficas em 99 episódios de febre reumática no Acre, Amazônia Brasileira / Clinical and demographic characteristics of 99 episodes of rheumatic fever in Acre, the Brazilian Amazon

OBJETIVO: Relatar as manifestações clínicas e características demográficas de pacientes com febre reumática atendidos em serviço público no Estado do Acre. MÉTODOS: Estudo de corte transversal em pacientes atendidos consecutivamente no Ambulatório de Cardiologia da FUNDHACRE, avaliados através de questionário contendo dados demográficos, clínicos e laboratoriais. O diagnóstico de febre reumática foi realizado através da aplicação dos critérios de Jones, em associação com dados laboratoriais, eletrocardiograma, radiografia de tórax e ecocardiograma bidimensional. Excluídos portadores com outras cardiopatias, diabetes, obesidade, doenças inflamatórias, processos infecciosos, tabagismo, gestantes, uso de drogas anti-inflamatórias ou reposição hormonal. RESULTADOS: De julho/2003 a fevereiro/2004, foram avaliados 99 pacientes com febre reumática aguda (idade média de 11 anos, dp= ± 10,18) com predominância feminina (59,6 por cento) e fenótipo racial mestiço de índio (60,6 por cento). Excluídos 3 indivíduos, por não preencherem os critérios diagnósticos. A idade média de início foi de 9,1 anos, sendo que em 30,4 por cento dos pacientes a doença foi diagnosticada no primeiro episódio de atividade reumática. As manifestações clínicas mais freqüentes foram cardite (69,7 por cento), artrite (21,4 por cento) e coréia (6,1 por cento) e a regurgitação mitral (36,4 por cento) a lesão mais comum seguida da associação de regurgitação mitral com aórtica (9,1 por cento). CONCLUSÃO: Cardite reumática foi a manifestação mais freqüente de febre reumática, predominando no grupo racial mestiço de índio (60,6 por cento), A baixa aderência à antibioticoprofilaxia contribuiu para recorrências e seqüelas cardíacas.

[Diagnosis and treatment of solitary thyroid nodule--study and evaluation in Portugal]. / Diagnóstico e tratamento do nódulo solitário da tiróide. Estudo de Avaliação em Portugal.

INTRODUCTION: The best diagnostic and treatment strategy for an approach to the nodular thyroid disease continues to be a controversial issue. OBJECTIVES: The aim of this study was to characterise medical practice in the diagnosis and treatment of nodular thyroid disease by endocrinologists and surgeons in Portugal in 2002. METHODS: A questionnaire based on that used by the European Thyroid Association and the American Thyroid Association was drawn up. The questionnaire, based on a well-defined index case, was circulated by the Portuguese Endocrinology Society to endocrinologists and surgeons: 42 year-old woman with solitary thyroid nodule measuring 2 x 3 cm, with no history of malfunction or painful symptoms. Each doctor was asked to reply as to the adopted diagnosis and therapy procedures for the index case. Eleven variations to the original case were proposed in order to evaluate the alterations for each variation. RESULTS: 1492 questionnaires were sent out, 163 to endocrinologists and 1329 to surgeons. A total of 104 were returned. The global response rate was 7%. The response rate for endocrinologists was 27% and 4.5% for surgeons. Of the 104 questionnaires returned, 42% were from endocrinologists and 58% from surgeons. Concerning tests prescribed, surgeons would use more tests than endocrinologists for the index case. The main differences in laboratory terms were the higher number of prescriptions for total T4 and T3 and thyroglobulin by surgeons and more prescriptions for AATPO by endocrinologists. The average number of tests was 4.6, 4.1 for endocrinologists and 5.1 for surgeons. Relative to imaging and cytology, 32% of doctors advocated a scintigraphy to diagnose the index case, with no significant differences between endocrinologists and surgeons. Ultrasonography was used by over 85% of respondents. 90% prescribed a cytology, 83% guided by palpation and 18% ultrasonography-guided. Concerning treatment, 33% of doctors advocated levothyroxin treatment; surgery was advocated by 16.3% of endocrinologists and 36.6% of surgeons. Meanwhile, the majority of doctors (68%) would opt for no treatment and simply maintain the patient under surveillance. CONCLUSIONS: There are important differences in the approach to nodular thyroid disease among the various doctors and specialists, which highlight the difficulty in achieving a diagnostic and therapeutic consensus.

[Hyperthyroidism and pregnancy]. / Hipertiroidismo e gravidez.

The authors describe most common hyperthyroidism aetiologies that occur during pregnancy and also the immunity changes that define Graves' disease and the immunity tolerance associated to pregnancy. They also refer the clinical picture, laboratorial diagnosis and the treatment to be carried out. Medical treatment is mostly based on anti-thyroid drugs. Their characteristics and use during pregnancy are discussed.

Abrindo espaços para psicologia

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